David NewmanSpeech Language Pathologist - PDF document

The Lateral Lisp David NewmanSpeech Language Pathologist www.speechlanguage - resources.com ��2 Created by David Newman SpeechLanguage Pathologist A Friendly Reminder© David Newmonic Language Games 2013 2016This book and all its contents are intellectual property.No part of this publication may be stored in a retrieval system, transmitted or reproduced in any way, including but not limited to digital copying and printing without the prior agreement and ritten permission of the author © All illustration s by David Newman ��3 Created by David Newman SpeechLanguage Pathologist The lateral lisp The lateral lisp has perhaps bedevilled more speech pathologists than any other commonly occurring speech sound error. The lateral lisp is arguably the most difficult sound error for children to get right despite speech pathologists’ best intentions anhours of fruitless intervention. What is a lateral lisp?Similar to other types of lisps, the lateral lisp affects the /s/ and /z/ speech sounds. A lateral lisp is a speech error where the airstream for the /s/ sound that is normally directed through the centre of the oral cavity over the midlineof the tongue is instead thrust down laterally around the sides of the tongue. So instead of a lovely, sibilant, hissing /s/ the child produces an unattractive windy, slushy noise where the sound swirls out of the sides of the mouth rather than direct through the centre of the mouth.The mouth structure that the child adopts for the lateral /s/ is considerably different from the mouth structure thatproduces a normal /s/ sound. Atypical /s/ is produced when the lateral edges of the tongue lightly touch the upper teeth. This constructs a valley down the centre of the tongue. The airstream is guided through the narrow compression created by the tongue, producing a clear /s/ sound. The mouth construction for the lateral lisp is somewhat different. The most prominent variations are that the tongue tip touches the alveolar ridge and the lips are drawn back wide. The jaw is retracted posteriorly. All of these structural changes alter the oral cavity, directing the airstream downand around thesidesof the tongue and out of the sides of the mouth. ��4 Created by David Newman SpeechLanguage Pathologist Lateral lisp experiment A quick experiment you may try is to shape your own mouth for the lateral /s/. To do this position your tongue tip firm against the alveolar ridge. Next, try to produce a normal /s/ sound without moving the tongue tip from the alveolar ridge. Do that now What did you notice? You probably can’tproduce a normal /s/! During the experiment you may have noticed thatthe tongue automaticallyredirectsthe airstream. To produce the lateral /s/ sound, which is essentially a variation of the normal /s/ sound, you must direct the air pastthe obstruction of the tongue tip against the alveolar ridge. The only routefor the airstream is down and around the sides of the tongue. Note also how your mouth accommodates this new and novel airflow by stretching wider to allow the air to flow out of the sides of the mouth. This fairly crude experiment should give some insight into what a child is doing to produce the lateral /s/.Lateral lisp Intervention Bite BlockThe lateral lisp can be corrected, but it does require some initial preparation. A child is taught the correct tongue placement and mouth structure with the initial use of a biteblock. A biteblock, also known as a mouthprop wedge, can be purchased from any dental supplier. An alternative to a biteblock is for the child to use his or her own thumb, preferably sanitized. ��5 Created by David Newman SpeechLanguage PathologistThe child is instructed to position the biteblockthumbin the corner of the mouth.(It doesn’t matter if it’s the left or right side of the mouth, so long as it’s comfortable) Model the correct placement by using your own thumb as a biteblock in your own mouth, the child then positions his/her thumb in his or her mouth. The advantage of using a bite block is that it prevents the jaw from moving during intervention and makes it a relatively stable structure. Recall the experiment where you produced the lateral /s/ your jaw retracted and your mouth cavity broadened. A stabilized jaw helps to prevent this movement. Model the bite - block with your thumb The biteblock prevents the child from moving his or her jaw during intervention and enables the tongue to move autonomously without being shackled to jaw movement. This gives the clinician a distinct advantage when teaching correct tongue position for the target /s/ sound.Lateral lisp Intervention /t/ soundThe next step, once the jaw has been stabilized with a bite block, is for the child to produce an aspirated /t/. The /t/ sound is produced by placing the tongue tip against the alveolar ridge which is followed by an explosive release as the tongue is lowered and the air is released in a puff. Explain to the child that the /t/ is a plosive sound and ��6 Created by David Newman SpeechLanguage Pathologistthat our goal is to learn the /t/ sound and, later, its cousin the /ts/ sound. Do not mention the /s/ sound at this stage.Model the correct /t/ with your biteblock positioned in yourownmouth. The child en copies your model, with thebiteblock or thumb in his or her own mouth. Explain that the /t/ sound is made by contacting the alveolar ridge with the tongue tip followed by an explosive release as the tongue is lowered. Once the child is able to consistently produce a nice, clear /t/move onto teaching the child the /ts/ sound combination.Lateral lisp Intervention tsExplain to the child that the /ts/ is not a realsound but is in fact the name of a strange creature that will only answer to its name said correctly, so we need to say the name correctly. The creatures name is t. Note that the target sound is the /s/ tacked onto the /t/ sound. At no stage mention the /s/ sound as being the target or the sound we are working on, otherwise the child will automatically revert to the lateral /s/. The creature’s name is disguised for those students who can read. Once again model the target sound with the biteblock or your thumb in your mouth. Produce a number of /t/ sounds rapidly t t t t t t t t. The child then copies your model. Model the rapid fire /t/ sounds but now elongate the lastsound this will happily be the /s/ sound, t t t t t t ssssssss . The child again copies your model. The /s/ sound is produced automatically in this model because the jaw is stable, the tongue is released from the alveolar ridge and the airflow is flowing over the midline of the tongue. At this stage the child should have no awareness that he or she has produced the correct /s/ sound which is partof our goal at this stage. ��7 Created by David Newman SpeechLanguage PathologistLateral lisp Intervention call the tcreatureOnce the child is able to produce a consistent /ts/ with the biteblock, try this activity. It’s a useful method of practising the new sound while it is still relatively unstable. The child has to call the t(/ts/). The tis very shy and only responds tothe right sound. We want to lure the tout of his cave. Once again place the biteblock in your mouth and model the sequence below. Position character pieces in front of child when needed.‘We have to lure the /ts/ out of his cave. He’ll only come out if we use the right sound. Try this after me t t t t t t t.’‘Oh look. It’s working. Let’s try his name now t t t t t sssssss‘Ooh, here he comes. He’s nearly here. Let’s call him again. t t t ssssssssss’‘If we’re very lucky, he maylet us pat him. Let’s try. But we’d better say his name first so he doesn’t bound away, t t ssssssssssssssss’ ��8 Created by David Newman SpeechLanguage PathologistLateral lisp Intervention /s/ without /t/ The next stage in acquisition of the correct /s/ sound is for the child to consistently produce the target sound without the /t/ prompt. Ensure that the child can produce a sustained /s/ without first generating the repeated /t/ sound. To do this, model the target sound to the child with your biteock in place, so tsssssssssss. The child then repeats the tsss target until you are satisfied the sound is stable. Support the child’s efforts through these stages of sound acquisition with consistent and positive feedback about his or her tongue positionand correct sound. Reinforce that the tongue needs to be touching the alveolar ridge, then releaseand then sustain thelong/s/ sound but don’t refer to the tsssss sound as being /s/. Lateral lisp Intervention without biteblock At this point produce the tsssss sound with the biteblock or thumb removed, but with the mouth shaped in the same positionwith the teeth slightly apart. Position the biteblock in the corner of your mouth then slowly remove it, and maintain the same mouth position. Then raise your tongue so that it contacts the alveolar ridge and produce a single /t/, followed by a sustained but shortened ssss . The child is then encouraged to follow your model. Instruct the child to place the biteblock in his/her mouth, and then slowly remove thbiteblock maintainingthe same mouth position as if the biteblock were still in place with the teeth slightly apart. Encourage the child to place his or her tongue tip on the alveolar ridge and then release the tongue to produce the tssss . Once the child can do this comfortably, instruct the child to create the /s/ sound without first touching the alveolar ridge. The child should be now producing a correct and sustained /s/. ��9 Created by David Newman SpeechLanguage Pathologist References Secord, W.A. (2007) Eliciting Sounds: Techniques and Strategies for Clinicians 2Edition DELMAR CENGAGE LearningVan Riper, C. & Erickson, R.L. (1996) Speech Correction: An Introduction to Speech Pathology and Audiology. Allyn & BaconWilliams, A.L. McLeod, S. & McCauley, R.J.(2010)Interventions for Speech Sound Disorders in Children. Paul H. Brookes Publishing Co.